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13 Cards in this Set

A. One of the major sexually transmitted diseases worldwide
B Associated with lower socioeconomic status

Primary syphilis
-how long after exposure
-symptoms
-lasts

Occurs 3-4 weeks after exposure
-Consists of a skin lesion called a chancre. Shallow ulcer with raised edges that is soft and painless. Usually occurs in the genital area, but can be in other locations including the lip, oral mucosa, and rectum. Ulcer lasts 1- 5 weeks and heals

Secondary syphilis
-Occurs
-symptoms
-resolves

-6-8 weeks after exposure (up to 6 months)
-Consists of generalized rash and systemic flu-like illness. The rash is called a papulosquamous rash with discrete lesions a few millimeters up to 1 cm in diameter that have a scaly surface. This rash includes the palms and soles. Patients may also experience fever, myalgias, arthralgias, headache, hair loss, and mucous patches in the mouth and on genitalia during this stage. This stage also spontaneously resolves after 1-2 weeks.

Early latent syphilis

-Occurs
-lasts
-symptoms

-after secondary syphilis and lasts up to 4 years. There are no symptoms, but tests for syphilis will be positive

-4-20 years after exposure . Only 1/3 of untreated patients will have active disease.
- infiltrative process with proteinaceous material in various body locations, usually superficial.
Can be disfiguring, but usually doesn't cause major illness.
- will have cardiovascular disease: inflammation of major arteries including the aorta that can lead to aortitis, aortic dissection, and rupture.
-central nervous system disease: this can be a slowly progessive meningitis, spinal cord disease that causes peripheral sensory neuropathy (tabes dorsalis), or dementia

- There are biologic false positive results with this test, hence a positive must be confirmed with additional testing.
-The higher the titer, the greater the likelihood that the result is a true positive. For older patients with a prior history of syphilis, a higher titer correlates with' ongoing active tertiary disease.

Tests begin to turn positive 4-6 weeks after infection, hence some with primary disease will still have negative results. By secondary disease, all tests are positive. Nonspecific tests may revert to negative over time in untreated disease whether it remains active or not. Specific tests remain positive for life. Rough guidelines are:

Primary disease with a rash called Erythema Chronicum Migrans (unique, has circles), a discrete red rash that increases in size over a 1-2 week period to be several centimeters in size
Secondary disease with either cardiac manifestations mostly heart block or neurological manifestations most often individual peripheral nerve palsies
Tertiary disease with arthritis

relationship bw primary/secondary
-duration of entire illness

Of patients with primary disease: 10-20% will have secondary disease; of those with secondary disease 10- 20% will have tertiary disease. The entire clinical illness rarely lasts longer than I year

Diagnosis is

-by clinical history that includes appropriate rash, tick exposure, and serology

1 Endemic in other parts of the world, not U.S.
2 Transmitted to humans by ticks or lice
3 Clinical illness is characterized by relapsing fever: patient has shaking chills and high fever for 3-5 days, feels well for 4-10 days, then experiences the fever again. Relapses correlate with changes in the surface protein of the organism to the extent that the body believes it is a new infection.